Using Self-Reflection to Fight Inequity in Health Care

An obstetrician and gynecologist calls for self-reflection and action for white physicians to address racism in health care.

Inequities exist throughout nearly all aspects of health. A recent perspective article published in the New England Journal of Medicine articulated one way physicians can hold themselves accountable to making a change.

The author of the article, Deborah Cohan, MD, MPH, obstetrician and gynecologist at the Department of Obstetrics, Gynecology, and Reproductive Sciences and the Department of Family and Community Medicine, University of California, San Francisco, admits, “I am racist, shaped by the sometimes subtle tendrils of white supremacy deeply embedded in our culture.”

Dr Cohan said she began noticing her implicit bias when she started more deeply reflecting on her actions. For example, she noticed one day that she was sitting farther back than usual from a black patient in a hospital bed. After realizing she was doing this, she made an effort to move closer. When she had scheduled an appointment for a white patient when it wasn’t a clinic day, she asked herself, would she have done the same thing for a black woman? By beginning to notice these actions, however small, she was able to apply changes to her daily life.

As a first step, Dr Cohan recommends learning to question thoughts and actions consistently, but with curiosity. Once the reflection has been made, commit to finding a way to change and improve. It is also important to surround yourself with others who will hold you accountable.

“If I truly want to be part of the solution, I need to explore those parts of me that are most unwholesome, embarrassing, unflattering, and generally not discussed in the context of one’s career,” said Dr Cohan.

“So what am I, an obstetrician, doing about the disproportionate burden of maternal mortality and other poor reproductive outcomes among black women? How am I confronting the underlying forces that facilitate increased suffering and death among certain groups because of their skin color?”

She concludes, “Until I bring to light and hold myself accountable for my own racist tendencies, I am contributing to racism in health care.”